Transcript of a BriefingsDirect podcast on how a major healthcare provider has used advanced IT management and operational efficiency processes and systems to keep applications up to date, compliant,
…

Transcript of a BriefingsDirect podcast on how a major healthcare provider has used advanced IT management and operational efficiency processes and systems to keep applications up to date, compliant, performant, and protected.

Transcript

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Millennium Pharmacy Takes SaaS Model to New Heights ViaPolicy-Driven Operations Management and AutomationApproachTranscript of a BrieﬁngsDirect podcast on how a major healthcare provider has used advancedIT management and operational efﬁciency processes and systems to keep applications up to date,compliant, performant, and protected.Listen to the podcast. Find it on iTunes. Sponsor: VMwareDana Gardner: Hi, this is Dana Gardner, Principal Analyst at Interarbor Solutions, and yourelistening to BrieﬁngsDirect.Today, we present a sponsored podcast discussion on how an onlinepharmaceutical services provider Millennium Pharmacy Systems, Inc. hasimplemented a variety of software-as-a-service (SaaS) applications and thenmanaged them through a more automated and efﬁcient operational approach.Well learn how Millennium Pharmacy has used advanced IT management and operationalefﬁciency processes and systems to keep applications up to date, compliant, performant, andprotected.To hear more detail on how automation and operational efﬁciencies help them improve theirbusiness results and customer retention, please join me in welcoming Leon Ravenna, VicePresident of IT and Operations and Information Security Ofﬁcer at Millennium PharmacySystems, Inc., based in Cranberry Township Pennsylvania. Welcome, Leon. [Disclosure:VMware is a sponsor of BrieﬁngsDirect podcasts.]Leon Ravenna: Good afternoon.Gardner: Were glad you could join us. Tell us a little bit about your state. What was thesituation in your organization that made it clear that the way youhad been doing it in the past was not holding up and that some newlevel of optimization, organization automation, improvement wasneeded?Ravenna: Ill be happy to. Ive been here about 14 months. One of the things that we looked atdoing right, when I came in, is taking both the data centers that we have -- one is owned and oneis a co-located facility -- and eliminating a lot of the older hardware that we had.We are now about 85 percent virtualized. Our primary datacenter is for our customer-facingapplication, a SaaS application, built on SQL/.Net and Silverlight, for about 250 nursing carefacilities on the East Coast. This basically controls all of the medications that a patient would

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need. It does our medical reordering and passes that information in an entirely integrated fashionback to our in-house systems for billing and ﬁlling of prescriptions.What we looked to doing ﬁrst was consolidating, getting rid of the older hardware, and movingus to a much better state. One of the nice things about VMware is that it’s just rock solid. Werekind of weary of knocking on wood, but it’s rock solid for us. It gives us the ability to moveapplications on an as-needed basis. We can upgrade things on the ﬂy. In one data center, we arecurrently on 5.1, and were moving the other data center to 5.1.On our SaaS application, I have 250 separate SQL databases on seven SQL servers, running in aVMware environment and that helps me dramatically cut my licensing cost for SQL server andhelps to manage them in a high availability way.Gardner: Leon, before we get more into what you do and why you have certain requirements,Id like to get a bit more information about what was different before you went to highvirtualization. Everybody talks about the efﬁciency in cost utilization, but what about themanagement? Is there something about the way youve done this that has allowed you to be 24x7up and keeping the performance where it need to be?More efﬁcientRavenna: We had a couple of older Dell blade chassis, and inevitably you would lose thepower supply or a server, and I just don’t have that. From an operational standpoint, it just helpsto be more efﬁcient. It has the ability to turn new servers up faster. It’s not something that we doall the time, but it helps me be much more efﬁcient. I have a fairly small staff, and my goal is tolet them sleep at night.By having more VMware in place, about 85 percent virtualized, it allows me to do that. If theserver fails, they applications move to a different server. I have the ability to upgrade the serverson the ﬂy. It allows me, from an operational standpoint, to be more secure in what were doing.And it helps me lower my cost, because I am not as worried about my HVAC. I have lessequipment to worry about. I have less break-ﬁx to worry about. All in all, it helps me beremarkably more efﬁcient.Gardner: Let’s learn a bit more about Millennium Pharmacy. Youre in the healthcare ﬁeldwhich of course has already got pretty stringent requirements in terms of compliance,regulations, cost, audit trails, and making sure that data is available. Tell us about what you doand then perhaps a bit about why your requirements are pretty dramatic.Ravenna: As I said, we host a system for about 250 nursing-care facilities. As a patient, youdon’t have much time with your nurse. The nurse is typically gathering your drugs. We have ourown pharmacies that service those homes. We deliver, in a cellophane sealed package, yourmedications.

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These packages say, "Mr. Smith, take this at dinner time." Theres a barcode for every drug, andwhen the nurse gives them the drug, they use a wireless scanner to scan that barcode and itautomatically reorders the next set of drugs. We give patients about a three- or four-day supply,as opposed to 45- or 90-day supply, which cuts the cost for the nursing care facility itself. Then,we manage all of that data back to our other systems, that manage the ﬁlling of new prescriptionsand billing and then we deliver every day.The healthcare space is fairly stringent, and and getting more so with the new HIPAAregulations. New ones just came out on March 26 of this year, and the enforcement and penaltiesare much greater. There’s some signiﬁcant items that have changed, but really it’s theenforcement and penalties, things around encryption, and protecting customers data.We also have to protect conﬁdential information and so we need to be very secure. Wereworking to implement the new HIPAA regulations so we can be even tighter in that space.Gardner: This is all done through SaaS and cloud. There are no on-premises installations ofyour application. Is that right?Ravenna: Only one facility of our 250 that has their own system. They are large, and one oftheir requirements was to have their own, but we support the rest of them, approximately 250, allcloud based. They can get to it from their Internet connection.All SaaSDepending on what the customer needs, we may set up the entire environment for them,networks, wireless, scanners, and printers, or they get to us through their own equipment andinternet connections. But yes, its all SaaS. Gardner: Were talking about being highly mission critical, people getting their medicine. Werealso talking about being highly efﬁcient. What were some of the requirements in terms of theinfrastructure, particularly as we look now towards managing so many different instances and theability to be agile and ﬁre up new versions of VMware and to get those apps up and running?What were some of your requirements just from a management perspective?Ravenna: It had to be easy. I have three system engineers. I only have a couple of networkengineers. We support, on the network side, approximately 250 VPN tunnels out to customers,and as you said, its mission critical. If people don’t get their drugs, it’s a bad day. We take thatmission very seriously, making sure those systems are up and running.From an operational or management standpoint, we really need to be monitoring to know what’shappening and when. Having VMware in that mix gives us the ability to make things consistent,but it also helps to reduce our cost from a licensing standpoint and helps us manage them better,because we can see what’s happening at any given moment.

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Gardner: So as a mid-market organization, youre resource constrained, you just don’t have ahuge stuff, and you need automation. You need to have the ability to manage things, perhapsremotely.So its this notion of total approach to management, rather than silos, rather than integration ofdifferent management approaches and products together. That just wouldn’t ﬂy. What have youdone? What have you experimented with, as you move towards this more complete notion ofmanagement, one-stop shop, one pane of glass type thing?Ravenna: There are a couple of things that weve done. Were evaluating vCenter OperationsManagement Suite. One of the things that it has let us do is dramatically reduce the size of ourvirtual machines (VMs).Typically, if youre moving from a physical environment, VMware is a lot more efﬁcient and it’sreally kind of surprising seeing some of the reports that come back from vCenter OperationsManagement that tell you, realistically, you are running this server with six gigabytes of memory,but you are only really using one.It’s a little bit spooky to look at it and ask if we really want to go that far. In some cases wewould say, "Yes, let’s go ahead and do that," and it’s been, for the most part, dead-on. Wevelooked at a couple of things where our gut didnt say it was the right thing, even though itprobably was. Theres still a little bit of that old-school mentality that says you need to get moreresources, when in fact the server may not even need them.It lets us be a lot more efﬁcient with what we are doing. It lets us manage more efﬁciently,because I can put more databases or more servers on each VM host.Move quicklyGardner: So when you look at the total picture, you need to be agile and able to move yourresources quickly. You have a small staff. You need to be compliant in the tough conﬁnes of thehealthcare regulatory environment.Where do you look to go next? Is there a higher vision that you develop? We hear about thesoftware-deﬁned datacenter, for example. We hear about cloud computing where you canactually mirror your entire data center from one location to another, maybe it’s for disasterrecovery (DR), maybe it’s just for operational efﬁciency. Is that on your radar? Is that what youlike to see?Ravenna: Absolutely. I have an overriding philosophy, after doing this for last 20 plus years.The simpler I can make it, the more I get to sleep. Sleep is a recurring theme and realistically,that means fewer calls during the night.

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Were looking to move to vCloud Suite, in particular Site Recovery Manager (SRM), and usingthe vCenter Operations Management Suite to allow us to be more efﬁcient. It just helps us workbetter and faster. Some of the key components will help me to be as efﬁcient as possible. I mayeventually need to build out virtual data centers, so the VMware vCloud Director helps me.Those are some of the key things Im looking for in the future. For me, having multiple datacenters, the ability to have VMware SRM, is just a great thing. It’s getting ready to thunderstormhere, and having the ability to move my services to a different data center that’s about 35 milesaway is key.Gardner: It’s pretty interesting that the notion a one-size-ﬁts-all, plain vanilla, public cloudwouldn’t be attractive to you. What would you like to see and what have you heard fromVMware that might lead to believe that they would be in a position to offer such as cloudservice?Ravenna: I don’t know that VMware has that today, but it’s a trusted brand, and Im very leeryabout putting my data just in a cloud with everybody else. It would have to be very speciﬁc to thehealthcare space, because you end up signing a business associate agreement with me.It would have to be what I would term carrier-class facilities that can prove they are in thehealthcare space, dedicated to being there, and abide by all the HIPAA Rules. We have all of thethings like PCI and SSAE 16. Those type things really need to be there and geared towards thehealthcare space speciﬁcally for me to be able to look at them.Gardner: And completely invisible to the end user. Theyre still getting their meds, making theirorders, and everything is up and running. That’s a great vision. Do you see the vCenterOperations Management Suite as a key stepping stone to getting there? It seems to me that youcan’t get to that vision until you really rationalize, organize, and lock down your operationalintegrity of what you have to play.Ravenna: Yes. It will be key component. In concert, the VMware Operations Management Suiteand the vCloud Suite will help me get there. My whole goal is to be able to make things assimple as possible and as easy as possible to manage, and these tools let me do that and be moreefﬁcient.No choiceIm not a guy who wants to understand electricity or heating and ventilation, but unfortunatelyin the world that we live today, in the mid-market space, you have your own data centers. Youhave no choice. You have to play in that game. Anything that I can do that helps me to addressthose issues to run cooler or run with less equipment is just all goodness.Gardner: As you have attained 85 percent virtualization and youre looking for efﬁciencies inyour storage and your resource utilization, is there a payback that you can take to your higher

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ups? When it comes time to invest and go further down this journey, with that fully realization ofcloud and ease of moving payloads, workloads across distances that, do you have metrics? Canyou say, "Listen, Im saving x percent?" How do you convince the bean counter that this is theright thing to do?Ravenna: It’s not necessarily a metric, but when youre spending less year over year onequipment, that’s evidence. Every server you buy is going to be in the roughly $5-$10,000 range.If Im not doing that, Im agile and nimble in being able to say that I can accommodate that.Thats opposed to the old process which was, get the capital done, go to ﬁnance, and wait sixweeks to get a server, and then put it in. Inevitably there is something that’s constrained. So thatsix-week lead time becomes eight or ten weeks. It just helps me to move faster and spend a lotless capital money.One of the things that I mentioned a little bit ago was licensing from a SQL standpoint, butthings like backup that are running on a per-processor standpoint within VM drop my overallcost.One of the things that it’s helpful as well is the dashboarding ability to be able to show what’sgoing on, what’s happening, and what the environment looks like. vCenter OperationsManagement Suite gives me that and its all goodness.Gardner: Leon, for those folks who might not be quite at 85 percent and who are trying to getthere for some of the reasons you just mentioned, what advice would you give them? What aresome of things that you’ve learned along the way to smooth that path to more managed,automated and agile?Ravenna: One of the things that you will inevitably hear is -- and this may be kind of an oldschool thing -- the application won’t do that. You know what, it probably will. You can’t take nofor an answer.Most of the applications that we have, our applications are all custom .NET and SQL. But a lotof the other applications we have just moved there, because it made sense to us.It make operations easier for me, but realistically, part of it is not taking no for an answer. Ifyoure comparing the cost of, say, a two processor server, and you are going to go buy four, ﬁve,or six servers, take one of those servers and put that investment into VMware and vCenterOperations Management. Youre going to be happier in the long term.Managing the managerGardner: It sounds like youve made a lot of progress and I wish you well. My last area ofquestions is around managing the manager, the vCenter Operations Management Suite. Have youhad to do a lot of training yourself? Did you go through it? How do you manage the personnel

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side in an organization like yours, where you do have still jacks-of-all-trades working in IT?What was the ramp-up in terms of the skills and the running of the management system?Ravenna: For vCenter Operations Management Suite, it wasn’t too bad at all. We were talkingto VMware, and they said it would be potentially beneﬁcial. We started up, ran it, and therereally wasn’t that much training that was necessary.The harder thing was when they came back and said we were over provisioned. That was making that rationalization that VMware is a lot more efﬁcient than physical hardware. It meanttaking some of our servers from 4 GB RAM down to one half that, because that’s where theyneeded to be. In some cases, you want to be a little bit safe. You ultimately ﬁnd out that the toolwas right, and you were being gun shy.Gardner: So you have more information at your ﬁnger tips, but sometimes it can be challengingto know what to do with it. I certainly understand that.Ravenna: Yeah, a lot of its interpretation.Gardner: Great. Weve been talking about how online pharmaceutical services providerMillennium Pharmacy Systems has implemented a variety of SaaS and other applications,virtualized them, and then managed that virtualization more to an automated operationsapproach. And we learned how this advanced IT management operation efﬁciency can keep thesemission-critical applications up-to-date, performant, compliant and protective.I want to thank our guest for joining us. Leon Ravenna. He is Vice President of IT Operations aswell as the Information Security Ofﬁcer there at Millennium Pharmacy Systems. Thanks somuch, Leon.Ravenna: Sure. Happy to help.Gardner: This is Dana Gardner, Principal Analyst at Interarbor Solutions. I want to thank ouraudience as well for listening, and don’t forget to come back next time. Listen to the podcast. Find it on iTunes. Download the transcript. Sponsor:VMwareTranscript of a BrieﬁngsDirect podcast on how a major healthcare provider has used advancedIT management and operational efﬁciency processes and systems to keep applications up to date,compliant, performant, and protected. Copyright Interarbor Solutions, LLC, 2005-2013. Allrights reserved.You may also be interested in:• AT&amp;T Cloud Services Built on VMware Cloud Datacenter Meet Evolving BusinessDemands for Advanced IaaS